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More Smoke and Mirrors on Mental Health

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eye on the news

More Smoke and Mirrors on Mental Health

Mayor de Blasio’s latest promises to the most seriously ill remain hollow. March 6, 2020
Health Care
Economy, finance, and budgets
New York

Mayor de Blasio and his wife Chirlane McCray, who serves as his mental-wellness czar, just announced an additional goal for ThriveNYC, their signature $850 million, multiyear mental-health plan: “Reach People with the Highest Needs.” One might think that that priority would have been part of the original plan. In any case, it’s a hollow promise: a close reading of the 2020–2022 ThriveNYC spending plan and “Progress Report” makes it clear that the de Blasio administration will continue to send money to ineffective programs, while giving short shrift to programs that reduce homelessness, arrests, and incarceration of the seriously mentally ill. The mayor and his wife justify the continuing ThriveNYC boondoggle by reporting meaningless and misleading statistics.

Over the last four years, de Blasio and McCray regularly insisted that ThriveNYC was helping the seriously mentally ill. In 2019, McCray told an incredulous city council that 100 percent of ThriveNYC’s funds are used for the seriously ill. The real figure is well short of that mark. New York City Council Speaker Cory Johnson says that only 13 percent of the program’s funds go to the seriously mentally ill. Gary Belkin, the program’s first director, pegged the figure at 19 percent; Susan Herman, ThriveNYC’s current head, says that in 2022 it will go up to 26 percent. 

In New York City, rates of homelessness, arrest, incarceration, violence, hospitalization, and calls to 911 involving the mentally ill are rising. Those critical metrics are not included in the ThriveNYC Progress Report, presumably because they’re trending in the wrong direction. Calls to the police for emotionally disturbed persons (EDPs) rose from 145,000 in 2015 to 179,000 in 2018. The number of seriously mentally ill homeless people in New York City rose from 9,840 in 2015 to 12,140 in 2018.

Clearly, ThriveNYC is failing. The elephant in the room: 41 percent of the most seriously mentally ill New Yorkers received no treatment in the past year. The program deserves to be judged on a simple metric: does it deliver treatment to the untreated seriously ill? If properly directed, ThriveNYC funds could make a real difference.

What’s not in ThriveNYC’s new spending plan is as important as what’s in it. The $235 million annual budget includes only a token $1.2 million for Kendra’s Law, New York’s most effective program for the seriously mentally ill. Kendra’s Law allows mentally ill individuals with a history of criminal behavior to continue to live in their communities, provided they comply with judges’ orders to undergo outpatient treatment, which often includes medications. With the help of Kendra’s Law, families of the mentally ill can keep their loved ones at home, rather than taking out orders of protection against them. In New York City, Kendra’s Law has reduced incarceration by 65 percent, hospitalization by 61 percent, and homelessness by 62 percent, for those who participate in the program. But lack of city support makes the program hard to get into for those who could benefit.

ThriveNYC’s new spending plan fails to fund mental health courts, which can drop charges against arrested mentally ill individuals if they comply with a judge’s order to stay in treatment for a certain period. Mental health courts prevent the seriously mentally ill from sliding into recidivism, but the courts can’t accept more cases because of the lack of housing available for the homeless mentally ill who come before them. The city council should allocate special housing to the five mental health courts.

Likewise, ThriveNYC doesn’t include funds for “clubhouse” programs like Fountain House, perhaps the best voluntary program for the most seriously ill. Clubhouses provide a physical location where the seriously mentally ill gain a sense of purpose and community through cooking, planning, cleaning, shopping, and other necessary daily activities. 

The 2021 budget does include $21 million for some useful case-management programs. But it sets aside another $34 million—almost half the total funds dedicated to “Strengthening Crisis Prevention and Response”—for an unspecified “Crisis Prevention and Response Task Force.” The seriously mentally ill don’t need another task force; they need funding for programs that work. The budget allocates almost as much money for school “consultants,” who don’t treat children ($9.9 million), as for clinicians who do ($10.9 million). Perhaps to make the resources assigned to helping the mentally ill look larger than they are, $14 million assigned to help crime victims was included in the total budget. But being a victim of a crime is not a mental illness.

ThriveNYC’s Progress Report includes almost no metrics for progress—only for process. It reveals, for example, how many people completed a training or used a service, but it says nothing about outcomes. And the numbers reported are cumulative from the program’s introduction, making the impact seem greater than if only annual numbers were included. For instance, 705,000 people have called or texted the NYC WELL Helpline since 2016—but that’s largely because the city is running ads telling all New Yorkers who feel “under pressure” to call. No ads encourage the seriously mentally ill or their families to call.

ThriveNYC is wasting $6 million a year on Mental Health First Aid, an all-day training course that teaches the public how to identify people so asymptomatic for mental illness that special training is needed to identify them. The problem, of course, is not our asymptomatic neighbors and coworkers, but rather the all-too-symptomatic people screaming on subway platforms. The administration portrays Mental Health First Aid as a success because 125,000 people enrolled in it. But providing useless training to large numbers of people is an example of failure, not success. Sixty-two thousand city employees, mainly in health care, took time off their jobs so that they could attend. That means fewer were available to help the seriously ill. Many ThriveNYC programs use “customer satisfaction” as a metric; satisfaction with a program that doesn’t make progress on a meaningful metric is itself a meaningless metric.

ThriveNYC’s new goal to “Reach People with the Highest Need” mostly consists of smoke and mirrors. The city council needs to get off the sidelines and bring some sanity to the mayor’s mental health plan.

Photo by David Dee Delgado/Getty Images

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